What prompts me to write this is a near tragic event here in the Silicon Valley, California involving an infant undergoing a febrile seizure (convulsions caused by sudden increase of brain activity). Upon calling emergency help, one fire brigade and one paramedic truck arrived within 3 minutes and an ambulance followed shortly after. The child was given athorough primary examination and an oxygen mask was put on her face; further medical treatment including Valium was administered by a qualified paramedic in the ambulance; according to the mother who was allowed to ride in the ambulance, it was in constant communication with the emergency room (ER) at the receiving hospital. An assembly of 15 doctors, nurses and medical emergency staff were ready to receive the child 10 minutes later. By then the child was fully unconscious and unable to breathe by herself.

For the next 75 minutes, as trains of medical staff went in and out, electric shock was given for resuscitation and the infant was put on artificial breathing apparatus. By some divine intervention and a lot of timely critical medical care the infant was stabilized. Over the course of the next hour, a CAT scan and a Meningitis test was carried out. Only after initial tests showed the crisis was over, the child was transported in an ambulance to a specialist pediatric intensive care unit in another hospital.

A paramedic was again with the child -- now heavily sedated, still unconscious and breathing through tubes. Another set of nurses, medical technicians and a senior doctor received them; all pertinent information was communicated to the new crew in a succinct written document by everyone starting from the fire brigade crew, the ambulance crew, the ER and the second paramedic. The child regained consciousness the next morning and was released two days later. The medical cost for all this treatment was about $40,000 -- paid for by medical insurance.

What's poignant about this story is that one of the other patients in the ICU was a teenaged Hispanic boy brought in a helicopter following severe abdominal bleeding from a gunshot wound. The incident occurred in a relatively remote place approximately 45 from the hospital and road transport in an ambulance would have easily taken over an hour.

According to the aforementioned website, in the quest for Mr. Kibria's emergency treatment precious time was lost time and time again as if in a horror movie where the protagonist uses every bit last breath in search of respite and shelter only for the place to turn out to be the depths of hell. It took 30 minutes to get Mr. Kibria to the local Habiganj General Hospital that didn't even have enough cotton for a bandage not to mention saline.

The obvious question is why is that hospital even open if it cannot provide the minimum level of care? Then a somewhat irrational decision was made to take him 100 miles south to Dhaka instead of 55 miles north to Sylhet a private ambulance -- with a police escort and his private car in toe.

Alas, the ambulance ran out of fuel after only 5 miles; how could the driver of the not know this before embarking on a 100mile long journey? Another precious 40 minutes are lost in hunt for diesel as Mr. Kibria's personal driver had to travel a total of some 20 miles west and back to Jagdishpur! After driving for another half an hour, Kibria's ambulance arrived at Madhabpur Government Hospital only to discover there was no doctor on duty; 15 minutes later, Kibria was transferred to a government ambulance and the convoy set off for Dhaka. Alas, when it arrived at the gates of Birdem nearly four hours after sustaining the grievous injuries, Mr. Kibria had already died.

What concerns me the most about this episode is the apparent lack of any kind of communication or co-ordination for medical and logistic assistance. As I understand it, mobile phones are in regular use in Bangladesh and work pretty well. I imagine the signal coverage is especially strong along a national highway that Kibria's convoy seems to have taken. Without the slightest intent to point fingers at anyone, I ask why couldn't someone call hospitals ahead of the convoy arriving there? In spite of the panic that ensued, what are the medical protocols for coordinating an effort like this? Why couldn't anyone summon a helicopter? Even though it must have been dark, it would not have been impossible to locate the convoy especially since there was a police escort.

Another controversy has been created by claims that offers of helicopter transport were turned down. Who made the offer and to whom? Who turned it down? If attempts were made to contact higher authorities for assistance, technically it is a simple enough task to go through people's phone records and establish the facts. Every phone call, whether it is from a fixed or a mobile set, is recorded by the telecom service provider (for routing and billing purposes) and it should be easy for them to reveal who called whom, when the call was made and how long the call lasted. Given the will, I am sure the forensic experts will be able to paint an accurate picture of what really happened and although too late for Mr. Kibria, valuable lessons can be learnt to avoid a repeat of our collective failures.

From a medical point of view, the bottom line is saving lives. Is it time to start thinking about introducing a centralized dispatch system with a single call-in phone number for the emergency services? What are the views of the doctors and nurses? According to a former doctor at Sylhet Hospital, a lot of precious time is lost as emergency staffs are inundated with phone calls from influential quarters in high profile cases; a lot of pressure is put on them instead of letting them focus on their life saving task.

In country of nearly 150 million with a per capita income of under $400 who gets to decide who lives and who dies? Is it fair to compare Bangladesh with the US (per capita income is $30,000) where much of medical care is provided through private insurance with monthly premiums running up to a few hundred dollars per person? What about comparisons to a pseudo-welfare state like the UK (per capita income of $23,000) where healthcare is free? How much does it cost to administer a relatively simple medical treatment like providing saline, stopping bleeding and blood transfusion to save a life?

Shabbir A. Bashar, PhD writes from the San Francisco Bay Area, USA.